Sunday, May 03, 2009

Update: Ups and downs

Since I've been neglecting my blog for the last few months, I felt that I should give you all an update on Gabriel. When I last wrote about him in January, he had finally been hospitalized after all those months of being actively psychotic and non-functional. At that point the plan was to commit him to the state hospital. But once they had him back on Clozapine (the "gold standard" of antipsychotics), he rapidly improved. Within a week and a half, he was well enough that they were able to send him home from the local hospital. In fact, he's functioning quite well on half his previous dose. It's good to have him back.

On the downside, he spent last week in the hospital, because his blood glucose was sky high (875!). We've had to make considerable changes to our schedule and eating habits, and now he's on insulin injections, as well as oral medications. This crisis was a sobering one for me. I always worry about what will happen to Gabriel when I'm gone, and now this fear has increased exponentially. I know that if Gabriel doesn't have someone to care about him and supervise him closely, the path to life on the streets will be short, and that street life would be deadly for him, given his diabetes and his vulnerability.

I also feel what Martin Luther King called "the fierce urgency of now." I know that at some point Gabriel may not function as well as he does now, so I feel an urgent need to make his life as full as I can while he can enjoy it. So Marcus, Gabriel, and I are going to Colorado over Memorial Day weekend to a family camp at the National Sports Center for the Disabled in Winter Park. There are probably a lot of other things I should be spending my money on, but this urgency of now put the camp at the top of my priority list. Gabriel has never seen mountains and never been on an airplane, so I wanted him to have those experiences. In fact, we haven't taken a vacation in about 13 years. Now that I have the free time, I want to take the boys to see some new places and have some new experiences. We are very excited about the trip and I hope to post pictures and video when we get back.

Saturday, May 02, 2009

The end of the line: expectations collide with reality

And so I’ve come to the end of the line…the end of my 30 year career as an occupational therapist. I’ve been put on long term disability and terminated from my job. After 30 years of lifting kids at work and at home, the pain from my degenerative disc disease and spinal stenosis is unbearable, and the doctors say I shouldn’t be putting any more stress on my spine. Barring some medical miracle, I doubt that I’ll ever be able to return to this kind of work.

I have to say that, at the end of the line, my expectations had a head-on collision with reality. This certainly wasn’t the way I saw my career ending. It’s not that I ever imagined myself as a supervisor or department head. That’s just not my cup of tea. I hate telling other people what to do…I’d rather do it myself. I am the first to admit that I lack the organizational skills to manage or supervise, and that I have an aversion to paperwork that borders on a phobia. What I always loved about my job was working directly with the kids and seeing the progress they made.

But what I did expect was that all those years of experience would count for something in the eyes of my bosses and colleagues. I was wrong. I didn’t see Gen X and Gen Y coming. I guess I had always assumed that I would be supervised by people who were my seniors or at least my contemporaries, people who had respect for the knowledge and experience I had gained over 30 years. But, no, Gen Y disdains experience, you see. In their eyes, it only makes you out of touch and outdated: a dinosaur. In their opinion, it is irrelevant that I was practicing OT before they were born. So what if I had treated kids with disorders that they had never even heard of? So what if I had personally raised 10 kids with disabilities? (They felt quite qualified to give patients’ parents directions on managing behavior, even though they didn’t have even one normal child of their own.) I must have appeared to have no ambition and did not constantly promote myself, and to them those are signs of inferiority.

And, so, in the final 5 years of my career, when I felt that I had earned a measure of respect, I came up empty handed. When I signed on with the company, I was offered a respectable hourly compensation, based on my extensive experience. It was downhill from there. I first realized which way the wind was blowing when I attended my first Christmas party, when they announced the winners of Therapist of the Year. I’m embarrassed to admit it now, but I actually thought I had a chance that first year. But as I saw all of the 20- and 30-somethings step up to receive their awards, I realized that my time had passed. In meeting after meeting, I heard therapists praised for the astronomical numbers of visits they made each week, and realized that, given my declining endurance and energy, I could never compete. While the parents of my patients were often complimentary of my work, as their children made impressive progress, those positive words were never repeated by the bosses.

And then the downward spiral began in earnest. Those of us who had been offered a higher rate due to our years of experience saw our pay cut by 11%. This was a tremendous blow to me, as it signified a lack of respect for my accomplishments. With the onset of my son’s schizophrenia and then my dad’s death, I struggled with profound depression, but tried to keep plugging away. I was floundering financially because I was never given an adequate number of patients, and then I found out another therapist (one of the self-promoters) who worked in the same area was making 50 visits a week, compared to my 12 or 14. Last June I was given a mediocre job performance evaluation, and I was devastated, as I felt it was an evaluation that would have been given to someone right out of school. I have no doubt that the stress of that evaluation contributed to my heart attack the next month. I got an inkling that my decision to discharge a patient was being second-guessed between another therapist and the manager behind my back. I was quite disappointed that the milestone of my 30 year anniversary of practicing OT passed without mention. And then, the coup de grace: I recommended discharging a patient and his mother called the office to question that decision. Did the case manager and district manager express confidence in my professional opinion? Did they stand up for me and tell the mother that I had more experience than any therapist on staff? Nope…they arranged for another therapist to provide a second opinion, as if I were a rookie therapist.

And so my life’s work comes to an unceremonious end. No retirement party, no testimonials, no gold watch, no nothing. Just an envelope of COBRA forms in the mail and a last trip to the office to turn in my electronic equipment. The words of T.S. Eliot keep going through my head:

This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper.

But wait, I do have a testimonial. A few years ago I ran into a former student of mine, a young man with cerebral palsy. He was in first grade when I started working with him my second year of practicing OT, so he was in his mid-30s when I ran into him. When I told him who I was and that I was his OT in elementary school, he grinned and said, "I remember you. You taught me how to write and how to dress myself. You wanted me to be independent. My mother wanted me to be dependent, but you wanted me to be independent!" And that was better than any Therapist of the Year award.